P - 82633�.... E.:'�..
1•-015-268 [�4 REQUEST FOR ELECTRICAL INSPECTION ,=
Minnesota State Board of Electricity ��':: -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 -_ -
, (651) 642-0800 www.electricity.state.mn.us � ."`
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
NSP SAVER'S SWITCH
2819`.�
Calculate Inspectic
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transforme r/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom
Fee - This Inspection Request will not be
... /h Connrc FnTlan!`P. .i'17P Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
In
that I inspected the electrical
without the correct fee.
�ircuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
�.�J' �
herein on the dates stated:
Special Inspection `- I pat� 2��
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I I II I I�I IIIII IIIII III I IIIII �III II�I OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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* 1 0 1 5 2 4* !7/4/� �
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ N6' Inspection Other Than Rough-In: CTReady Now ❑ Will Call
� 14 ZOOQ You must call the inspector when ready! Date Ready:
I, [�Qicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code:
6201 C/4R�L DR NE FRIQLEY 55432
Section No. Township Name or No. Range No. Fire No. County
' f'U\ V �V'i
Occupant Phone No.
TEFF CORY C
Power Sup Address
NS � �
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRIC CORPORATI4N CA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
230Q TERRITORIAL ROAD , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone Number
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY